Abortion coverage: The new battleground for states

Conservative states may have lost their bid to kill Obamacare, but they’re winning the battle on another front: abortion coverage.

At least 20 states have banned or restricted the coverage of abortion procedures — including coverage in private insurance plans — revealing a new battleground in the arduous task of carrying out the controversial national health care law.

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States were explicitly given the authority to restrict abortion coverage — it was part of the overall deal. And now, states that aren’t even setting up their exchanges — and are letting the federal government run them — are exercising that power over abortion.

Abortion coverage nearly derailed the health law in 2010 — and that “raised the consciousness” of anti-abortion lawmakers, who saw an opportunity and seized it, said Kentucky state Rep. Stan Lee, a Republican sponsoring an abortion coverage ban for his state’s exchange.

“My legal argument as a lawyer is that to sell one of those policies through a health care exchange is in fact using public dollars” for abortion, he said. “That should be illegal.”

Abortion rights groups say they saw this day coming.

“Abortion coverage restrictions were a nonissue for an incredibly long amount of time,” said Elizabeth Nash of the Gutt- macher Institute. Then, along came Obamacare. “That law really encouraged states to go in and pass these abortion coverage restrictions in their own health exchanges,” she said.

Even in states that do allow coverage for abortions beyond the limited situations in which federal funds can be used, the money has to be “segregated” and the coverage paid for separately by health plan customers.

The wave of new state laws range from making abortion coverage in an exchange health plan illegal — except in cases of rape, incest or to save the life of the mother — to allowing coverage only through an optional “rider” that must be purchased separately, apart from any tax dollars used to subsidize health insurance for low- and middle-income people.

So far, 18 states have passed laws to restrict or ban insurance coverage of abortion in health care exchanges, according to Guttmacher. Two states – Kentucky and North Dakota – had older laws in place banning abortion coverage in all insurance plans.

Arkansas, Michigan and New Jersey have all introduced bills that would restrict abortion coverage in exchanges. Kentucky’s bill would make clear that the current restrictions apply within the new exchanges.

Anna Franzonello, an attorney with the anti-abortion organization Americans United for Life, predicted more states will follow. The health care law “creates a new concern that states didn’t have before about insurance plans covering abortion,” she said. “The [Affordable Care Act] creates all these new mandates, so the opt-out is a response to what otherwise would be a change in the status quo.”

Some states have gone beyond exchange restrictions. After the health law was signed in the spring of 2010, three states — Kansas, Nebraska and Utah — went ahead and banned insurance coverage of abortion, except in certain cases — for all private insurance plans in the state, in and out of the exchange. A total of eight states now have similarly broad restrictions.